015700239-6-17-2021-52-CC-LDBX-C43VLV-20210617163233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700239
Report Date: 06/17/2021
Date Signed: 06/17/2021 04:32:45 PM

Document Has Been Signed on 06/17/2021 04:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	JONNALAGADDA, NAGA		FACILITY NUMBER:	015700239
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/17/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Nagadurga Johnnalagadda		TIME COMPLETED:	04:45 PM

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On June 17, 2021 at approximately 1:30 PM Licensing Program Analyst (LPA) Lorraine Dacanay Breaux and (LPM) Chandra Charles met with applicant Nagadurga Jonnalagadda, for the purpose of conducting an announced pre-licensing Health and Safety compliance inspection. Present during the inspection was applicant’s fingerprint cleared husband Sathyakpra Tadepalli, and their 10 and 5-year-old daughters. Applicant advised the hours of operation of the day-care will be Monday - Friday, 8:00AM to 6:00PM.

The home is single story which consist of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, a two car garage and a large enclosed (fenced) backyard. The home is neat and clean with heating and ventilation for safety and comfort.

There is a fireplace with glass door in the living room. Per applicant, there are no firearms in the home. A copy of the mortgage was reviewed and shows control of property by applicant and her husband.

The home is equipped with a working smoke and carbon monoxide detectors (tested and functioning), and a working telephone. The applicant’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 03/13/2023. The applicant completed and received a certificate in mandated reporter training (verified AB1207), expires on 04/05/2023. The applicant follows the immunization laws which pertains to day care providers.

Per the applicant, the ISOLATION AREA will be the living room outside of the main day-care room (converted garage) and away from the other children in care.

LPA reminded the applicant of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: JONNALAGADDA, NAGA	FACILITY NUMBER: 015700239
	VISIT DATE: 06/17/2021

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Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child

This home is not recommended for Licensure on 06/17/2021, until the following items have been obtained/corrected:

· Secure the outside climbing/slide play structure (not stable)

· A fully charged 2A10BC or higher fire extinguisher

· On ALL cabinets reachable to day care children install locks/latches in kitchen/bathroom for safety

· Remove any and all toxic/poisonous cleaning products reachable to day care children

· Install Gate in the hallway after the main bathroom

· Install Gate left side (facing the yard) of the house rear of the house leading to the shed to separate rear and right side of the yard (to distinguish the off-limit areas)

· Put pad lock on shed

· Replace slates on the fence

· Add pipe installation cushion around exposed water pipes connected to the house, remove debris near the play structure

· Recommendation: cot/mats for sleeping

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: JONNALAGADDA, NAGA	FACILITY NUMBER: 015700239
	VISIT DATE: 06/17/2021

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On-limit-areas include: the kitchen area passing the refrigerator, is (a walk-through area to gain access to the bathroom the day-care children will use.) Hallway bathroom is across from the off-limits 1^st bedroom.

Living room, the converted garage/bonus room which has been converted into a children playroom.

The off-limit areas: The dining room which has be converted into an office, master bedroom with master bathroom, and the two additional bedrooms. Off limits areas will be inaccessible by closed and/or locked doors, and/or by adult supervision.

Outside Play area

The backyard is large completely fenced and divided into sections.
When facing the backyard, the right side has a climbing play structure with a slide. The center of the backyard has a grassy and concrete areas. The left side of the extended backyard around the home is a walkway that leads to a shred. All exterior gates have padlocks on them.

During today’s inspection LPA observed cleaning products, hazardous materials and toxins that could be accessible to child(ren). Cleaning products in bathroom drawers and rear of the shed.

LPA did not observe any bodies of water on the premises.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC809 (FAS) - (06/04)

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